Gait festination is one of the most characteristic gait disturbances in patients with Parkinson's disease or atypical parkinsonism. Although festination is common and disabling, it has received little attention in the literature, and different definitions exist. Here, we argue that there are actually two phenotypes of festination. The first phenotype entails a primary locomotion disturbance, due to the so-called sequence effect: a progressive shortening of step length, accompanied by a compensatory increase in cadence. This phenotype strongly relates to freezing of gait with alternating trembling of the leg. The second phenotype results from a postural control problem (forward leaning of the trunk) combined with a balance control deficit (inappropriately small balance-correcting steps). In this viewpoint, we elaborate on the possible pathophysiological substrate of these two phenotypes of festination and discuss their management in daily clinical practice.

Department of Neurology and Clinical Neurophysiology Schön Klinik München Schwabing Munich Germany

Department of Neurology Centre of Clinical Neuroscience 1st Faculty of Medicine General University Hospital Charles University Prague Czech Republic

Department of Neurology Donders Institute for Brain Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands

Department of Otorhinolaryngology and Head and Neck Surgery 3rd Faculty of Medicine University Hospital Kralovske Vinohrady Charles University Prague Czech Republic

Department of Rehabilitation Donders Institute for Brain Cognition and Behaviour Radboud University Medical Center PO Box 9101 Nijmegen 6500 HB The Netherlands

Movement Disorders Unit Sackler School of Medicine Sagol School for Neuroscience Tel Aviv Medical Centre Neurological Institute Tel Aviv University Tel Aviv Israel

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